Provider Demographics
NPI:1750988440
Name:SCHREIBER, NATHANIEL WAYNE
Entity type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:WAYNE
Last Name:SCHREIBER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:NATHAN
Other - Middle Name:WAYNE
Other - Last Name:SCHREIBER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:9612 KILDARE XING
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46835-9368
Mailing Address - Country:US
Mailing Address - Phone:260-205-0459
Mailing Address - Fax:
Practice Address - Street 1:2016 N WAYNE ST
Practice Address - Street 2:
Practice Address - City:ANGOLA
Practice Address - State:IN
Practice Address - Zip Code:46703-9102
Practice Address - Country:US
Practice Address - Phone:260-665-7033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-06
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26028733A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist